Hospital Universitario del Henares

Since the release of ChatGPT, numerous LLMs have emerged, providing easy access to information without the need for technical expertise. However, relying on these systems can influence important life decisions, such as the choice to use epidural analgesia during childbirth. Epidural analgesia is widely regarded as the "gold standard" for pain relief during childbirth. However, limited access to anaesthesiologists and gaps in knowledge may prompt individuals to seek information from unverified sources, including AI systems. Misinformation in this area can discourage the use of effective analgesia, highlighting the need to assess the accuracy of LLM-generated content. To evaluate the reliability of LLM-generated information regarding epidural analgesia. We posed 10 standardized questions about epidural analgesia to 12 LLMs, each question reformulated 10 times in both Spanish and English, resulting in 2400 responses. Two anaesthesiologists were involved in the assessment process. One expert performed the initial ratings, while the second independently verified the evaluations assessing the outputs using an extended SERVQUAL framework. ChatGPT performed best, followed by Gemini 2. Medium-sized models, such as Phi-3 and OpenChat, outperformed several larger models like Llama-2 or Llama-3, challenging the notion that "bigger is better" and offering potential advantages in low-resource settings (e.g., Phi-3 outperformed Llama-2 with an average increase of 81% across all metrics). Specialized models did not show superior performance. Except for ChatGPT, English responses were generally more reliable than Spanish, with some Spanish outputs incoherent. ChatGPT also exhibited the least variability between responses. Despite promising performance, LLMs display limitations in medical contexts. Collaboration between national and international medical societies is crucial to develop evidence-based resources to guide LLM training and improve information trustworthiness.

Human immunodeficiency virus (HIV) and other sexually transmitted infections (STI) are a major public health concern. Primary care (PC) is the ideal setting for their diagnosis. Designing effective strategies requires a thorough understanding of the problems these patients face when seeking care. To identify barriers and facilitators to the diagnosis of HIV and STIs in PC and classify them according to the theoretical Capability, Opportunity, and Motivation model of Behaviour (COM-B model). The review's findings will inform the development of specific intervention strategies. We conducted a systematic review (SR) of qualitative studies of barriers and facilitators to the diagnosis of HIV/STI. A systematic literature search, without publication date limitation, was performed in Embase, Cochrane Library, and Medline via PubMed. The Joanna Briggs Institute (JBI) scale was used to assess the risk of bias of the included studies. The results were synthesised and presented according to the dimensions of the COM-B model. Of the 1,366 records from the initial search strategy, 70 articles met all inclusion criteria, covering all HIV/STIs and different risk groups. Barriers and facilitators to diagnosis were identified at three levels: patients, professionals, and health system. Patient barriers included confidentiality issues, lack of risk perception, shame and stigma, and access. The barriers at the level of professionals were lack of training, time constraints, and scarcity of resources. Among the facilitators, the most notable were minimally invasive sampling methods, ensuring confidentiality, standardisation of tests, fast and efficient entry points, and professional training. This SR provides information on barriers and facilitators to HIV/STI diagnosis in PC and across the different stakeholders involved (patients, providers, system). The results are grouped into the different dimensions of a behavioural model (capability, opportunity, and motivation). A thorough understanding of the complexity of the behaviour of people diagnosed with HIV/STIs and all those involved in their management will enable the development of effective intervention strategies to diagnose and prevent these processes, thereby reducing the associated disease burden. Registration: International Prospective Register of Systematic Reviews (PROSPERO: CRD42023404578).

Background: This invited review addresses the steps involved in ensuring quality in interventional cytopathology. These include an understanding of its historical perspective and presenting a snapshot of current training and clinical practice. It provides examples of documentation of the FNA procedure and also guidance on the use of local anaesthetics and management of antithrombotic medication. Summary: The invited co-authors represent those actively involved in this field and bring a wide range of views that represents a step in the direction of producing up-to-date guidance for those aspiring to set up or to further improve their existing practice of interventional cytopathology. Key Messages: It is hoped that this collaborative effort will pave the way for standardization, ensuring quality in interventional cytopathology.

La Ley 7/2023, de 28 de marzo, de protección de los derechos y el bienestar de los animales, podría considerarse un avance significativo en la protección de los derechos y el bienestar de los animales en España, introduciendo un marco legal innovador que reconoce a los animales como "seres sintientes". Su objetivo principal es definir el marco normativo que permita obtener la mayor protección para los derechos y bienestar de los animales, tal como establece en su artículo 2. La legislación se centra en erradicar el maltrato y abandono animal, promoviendo la tenencia responsable mediante una serie de prohibiciones y obligaciones que afectan la vida de los animales de compañía. Más allá de un mínimo análisis legislativo como metodología, hay que plantearse: ¿Hacen caso a la Ley de Bienestar Animal? Este escrito pretende contribuir a dicho debate, con algunos ejemplos concretos, del Real Decreto 666/2023, de 18 de julio, por el que se regula la distribución, prescripción, dispensación y uso de medicamentos veterinarios, y de una experiencia en un pequeño municipio de la Axarquía de Málaga, con una colonia felina, con verdades a descifrar para futuras investigaciones del tipo: ¿estas leyes realmente mejoran el bienestar animal, o hace falta mucho más que normativas puntuales?

Among the Malawian infants living with HIV and hospitalized with severe pneumonia, bacteria (87%), viruses (85%) and fungi (40%) were detected in the respiratory tract. All infants had polymicrobial codetection, and differences in respiratory microbial codetection groups were significantly associated with age and HIV viral load.